D. Segev

Eculizumab and splenectomy as salvage therapy for severe antibody-mediated rejection after HLA-incompatible kidney transplantation.

Background Incompatible live donor kidney transplantation is associated with an increased rate of antibody-mediated rejection (AMR) and subsequent transplant glomerulopathy. For patients with severe, oliguric AMR, graft loss is inevitable without timely intervention. Methods We reviewed our experience rescuing kidney allografts with this severe AMR phenotype by using splenectomy alone (n=14), eculizumab alone (n=5), or splenectomy plus eculizumab (n=5), in addition to plasmapheresis. Results The study population was 267 consecutive patients with donor-specific antibody undergoing desensitization. In the first 3 weeks after transplantation (median=6 days), 24 patients developed sudden onset oliguria and rapidly rising serum creatinine with marked rebound of donor-specific antibody, and a biopsy that showed features of AMR. At a median follow-up of 533 days, 4 of 14 splenectomy-alone patients experienced graft loss (median=320 days), compared to four of five eculizumab-alone patients with graft failure (median=95 days). No patients treated with splenectomy plus eculizumab experienced graft loss. There was more chronic glomerulopathy in the splenectomy-alone and eculizumab-alone groups at 1 year, whereas splenectomy plus eculizumab patients had almost no transplant glomerulopathy. Conclusion These data suggest that for patients manifesting early severe AMR, splenectomy plus eculizumab may provide an effective intervention for rescuing and preserving allograft function.

Complement-Activating Anti-HLA Antibodies in Kidney Transplantation: Allograft Gene Expression Profiling and Response to Treatment

Complement-activating anti-HLA donor-specific antibodies (DSAs) are associated with impaired kidney transplant outcome; however, whether these antibodies induce a specific rejection phenotype and influence response to therapy remains undetermined. We prospectively screened 931 kidney recipients for complement-activating DSAs and used histopathology, immunostaining, and allograft gene expression to assess rejection phenotypes. Effector cells were evaluated using in vitro human cell cultures. Additionally, we assessed the effect of complement inhibition on kidney allograft rejection phenotype and the clinical response to complement inhibition in 116 independent kidney recipients with DSAs at transplant receiving rejection prophylaxis with eculizumab or standard of care (plasma exchange and intravenous Ig) at ten international centers. The histomolecular rejection phenotype associated with complement-activating DSA was characterized by complement deposition and accumulation of natural killer cells and monocytes/macrophages in capillaries and increased expression of five biologically relevant genes (CXCL11, CCL4, MS4A7, MS4A6A, and FCGR3A) indicative of endothelial activation, IFNγ response, CD16-mediated natural killer cell activation, and monocyte/macrophage activation. Compared with standard of care, eculizumab specifically abrogated this histomolecular rejection phenotype and associated with a decreased 3-month rejection incidence rate in patients with complement-activating DSAs (56%; 95% confidence interval [95% CI], 38% to 74% versus 19%; 95% CI, 8% to 35%; P=0.001) but not in those with noncomplement-activating DSAs (9%; 95% CI, 2% to 25% versus 13%; 95% CI, 2% to 40%; P=0.65). In conclusion, circulating complement-activating anti-HLA DSAs are associated with a specific histomolecular kidney allograft rejection phenotype that can be abrogated by complement inhibition.

Frailty and Surgery in the Elderly

Conventional surgical wisdom has long held that the elderly do not tolerate surgery as well as their younger counterparts. Numerous case series comparing outcomes such as morbidity and length of stay often corroborate that viewpoint. However, the older surgical population displays great heterogeneity, and that heterogeneity is not always obvious from preoperative morbidities and preoperative testing criteria. In fact, we have on numerous occasions been surprised by the elderly patient who beats the odds following surgery, and the patient who, ostensibly, should recover well, but does not.

Kidney Transplants from HLA-Incompatible Live Donors and Survival.

n engl j med 375;3 nejm.org July 21, 2016 286 As Spellberg indicates, whereas we found no significant between-group difference in early response rates, at 7 to 14 days after treatment, the participants who received treatment with trimethoprim–sulfamethoxazole had an abscess cure rate that was significantly higher (by 7 percentage points) than that of participants treated with placebo. At 6 to 8 weeks after treatment, these participants had significantly lower rates of new infections and drainage procedures. An alternative primary outcome, composite clinical cure, was lesion resolution without the addition of a new antibiotic or further drainage; the use of trimethoprim–sulfamethoxazole was also favored for this measure, by 12 percentage points. Our results elucidate the history of treated skin abscesses and challenge current FDA guidance, particularly the guidance for noninferiority registration trials. Leiner has concerns about the use of antibiotics becoming routine, and Pollara and Marks raise stewardship questions. Our findings are appropriately applied only to patients similar to our trial participants (i.e., those who have an abscess measuring at least 2 cm in diameter and whose clinician intends outpatient treatment). In our study, most abscesses measured 2 to 3 cm in diameter (with a median erythema length of 7 cm), but some were much larger. We agree that subgroup analyses of conditions for which there is a theoretical association with a greater antibiotic effect, such as larger size, could be informative. We will see whether another multicenter RCT (ClinicalTrials.gov. number NCT00730028) in which antibiotics are compared with placebo supports our findings and hope to validate subgroup treatment associations to further inform decision making. However, we have shown that trimethoprim–sulfamethoxazole (which typically has a cost of less than

ECULIZUMAB PREVENTS RECURRENCE OF ANTIPHOSPHOLIPID ANTIBODY SYNDROME (APS) IN RENAL ALLOGRAFTS: 2791

5 per course) leads to superior outcomes and is generally safe, which justifies discussion of this option with patients at the least. The risk of promotion of bacterial resistance is probably small with our regimen, since it involves the use of high-dose trimethoprim–sulfamethoxazole (320 mg and 1600 mg, respectively, twice daily) for 7 days in healthy, community-dwelling patients with an identifiable bacterial infection. We do not know whether a shorter regimen would be efficacious. The fact that some lesions were culture-negative or grew coagulase-negative staphylococci is probably due to the limitations of culture technique and not the presence of a nonbacterial cause of infection. David A. Talan, M.D.

Optimized Redistricting for Liver Allocation: Exploring the Impact of Choices By the Transplant Community.: Abstract# 620

B.E. Lonze1, N.N. Dagher1, C.E. Simpkins1, D.L. Segev2, A.L. Singer1, S. Cohney3, N. Alachkar4, R.A. Montgomery5 1Surgery, Johns Hopkins, Baltimore/MD/UNITED STATES OF AMERICA, 2, Johns Hopkins University School of Medicine, Baltimore/ UNITED STATES OF AMERICA, 3, Royal Melbourne Hospital, Parkville/AUSTRALIA, 4Medicine, Johns Hopkins, Baltimore/MD/ UNITED STATES OF AMERICA, 5Surgery, Johns Hopkins University, Baltimore/UNITED STATES OF AMERICA

Incidence of Hypertension in Living Kidney Donors and Matched Controls.: Abstract# 1383

621 The Imperative For Proactive Response To Policy Shift – Early Anticipation and Reaction to Unintended HCC Disadvantage in Share 35. T. Baker,1 V. Kilambi,2 D. Ladner,1 A. Skaro,1 S. Mehrotra,2 G. Hazen,2 M. Abecassis.1 1Department of Surgery, Division of Transplantation, Northwestern University, Chicago, IL; 2Department of Industrial Engineering and Management Sciences, Center for Engineering and Health, Northwestern University, Chicago, IL. Introduction: Recently, regional “share 35” (S35) was introduced to increase access to liver transplant (LT) for the sickest patients (MELD >35) while decreasing recognized geographic disparity. We hypothesized that contrary to perceptions that hepatocellular cancer(HCC) patient have been disproportionately advantaged by MELD exceptions, S35 will result in reduced LT access and increased mortality for HCC patients. METHODS: Using SRTR data(2011-2012), we performed a sophisticated discreteevent simulation of DDLT allocation for UNOS Region 7 before and after S35 . The model incorporates disease progression and measures waiting-times, LT rates, and pre and post-LT mortality at the regional and local (DSA)-level. Outcomes for discrete MELD groups (35-40, 25-34, 15-24, < 15) were examined to study the impact of S35 for patients with and without HCC. Results: Post S35, overall LT rate increased and pre-LT mortality decreased for MELD > 35 (+4.30%, -1.57%; p< 0.01). The 1-yr mortality for HCC patients, however, increased signifi cantly post S35 (15% vs 13.2%, p<0.05); the LT rate decreased and pre-LT mortality increased (p<0.02). The most dramatic effect was seen in HCC patients with MELD 25-34 (LT rate decreased 7.4% , mortality increased 4.9%). Compared with pre S35, higher DRI organs were allocated to HCC patients with MELD 25-34 post S35 (p<0.01). In region 7, the DSAs with the highest organ recovery rate experience a LT defi cit resulting in the most pronounced increase in HCC mortality for MELD 25-34. Conclusion: The policy shift with S35 complies with the dictum of the Final Rule enhancing outcomes for the sickest LT candidates while decreasing geographical disparity. The unintended consequences of this policy, however, may dramatically change the landscape of liver allocation particularly for HCC patients with MELD scores just below the policy threshold increasing waiting times and pre-LT mortality, forcing high DRI LTs and aggressive pursuit of living donor LT. A more thorough examination of whether the advantage of S35 outweighs the downside for HCC patients will determine the priority to reconsider this policy shift. Abstract# 622 Use of Elderly Allografts in Liver Transplantation. F. Paterno, A. Singhal, K. Wima, R. Hoehn, G. Wilson, D. Abbott, M. Cuffy, T. Diwan, S. Woodle, S. Shah. Division of Transplantation, University of Cincinnati, Cincinnati, OH. Purpose: Use of liver allografts from elderly donors has increased due to organ shortage and increased life expectancy of the general population. The aim of this study is to evaluate the current utilization of elderly donors in the United States, patterns of recipient selection, and their outcomes. Methods: Using a linkage between the Scientifi c Registry of Transplant Recipients and University HealthSystem Consortium databases, we identifi ed 12,445 liver transplant (LT) recipients between January 2007 and December 2011. Recipients were divided into two cohorts based on the donor age: ≥ 70 years (n= 540) and < 60 years (n= 10,473). A stepwise cox regression evaluated the impact of elderly donors on graft survival after adjusting for transplant related factors. Results: Elderly donors accounted for 4.3% of donors used in the fi ve-year period. Compared to younger donors, elderly donors were more likely to be females (53.9% vs. 39.0%, P<0.001), shared regionally or nationally (46.4% vs. 28.5%, P<0.001), and used at high volume centers (48.5% vs. 32.2%, P<0.001). The top three centers using elderly donors accounted for 1/3 of all elderly donors, and resided in Regions 7 and 9. The comparison between the two recipient cohorts showed that recipients of elderly donors were older (> 60 years: 47.8% vs. 29.1%, P<0.001), less likely to be on dialysis (2.6% vs. 8.1%, P<0.001), or inpatient at time of LT (16.9% vs. 21.7%, P=0.03), and had lower MELD score (>28: 13.2% vs. 23.0%, P<0.001). Both recipient groups had similar perioperative mortality, readmission rates, and long-term patient survival. Recipients of elderly donors were associated with increased graft loss (p<0.001). In the multivariate analysis, elderly donors were associated with increased risk of graft failure only when adjusted for recipient characteristics (HR 1.32, 95% CI 1.11-1.56) or center and regional factors (HR 1.23; 95% CI 1.04-1.46) individually; however, in the adjusted analysis including all these factors together, elderly donors did not carry increased risk of graft failure. Conclusions: Currently, the use of elderly liver allografts is limited to selected recipients (older age, less severe disease) by high volume centers in regions of high wait list mortality. Adjusted analysis of graft survival confi rms that the use of elderly donors in appropriately 622 Use of Elderly Allografts in Liver Transplantation. F. Paterno, A. Singhal, K. Wima, R. Hoehn, G. Wilson, D. Abbott, M. Cuffy, T. Diwan, S. Woodle, S. Shah. Division of Transplantation, University of Cincinnati, Cincinnati, OH. Purpose: Use of liver allografts from elderly donors has increased due to organ shortage and increased life expectancy of the general population. The aim of this study is to evaluate the current utilization of elderly donors in the United States, patterns of recipient selection, and their outcomes. Methods: Using a linkage between the Scientifi c Registry of Transplant Recipients and University HealthSystem Consortium databases, we identifi ed 12,445 liver transplant (LT) recipients between January 2007 and December 2011. Recipients were divided into two cohorts based on the donor age: ≥ 70 years (n= 540) and < 60 years (n= 10,473). A stepwise cox regression evaluated the impact of elderly donors on graft survival after adjusting for transplant related factors. Results: Elderly donors accounted for 4.3% of donors used in the fi ve-year period. Compared to younger donors, elderly donors were more likely to be females (53.9% vs. 39.0%, P<0.001), shared regionally or nationally (46.4% vs. 28.5%, P<0.001), and used at high volume centers (48.5% vs. 32.2%, P<0.001). The top three centers using elderly donors accounted for 1/3 of all elderly donors, and resided in Regions 7 and 9. The comparison between the two recipient cohorts showed that recipients of elderly donors were older (> 60 years: 47.8% vs. 29.1%, P<0.001), less likely to be on dialysis (2.6% vs. 8.1%, P<0.001), or inpatient at time of LT (16.9% vs. 21.7%, P=0.03), and had lower MELD score (>28: 13.2% vs. 23.0%, P<0.001). Both recipient groups had similar perioperative mortality, readmission rates, and long-term patient survival. Recipients of elderly donors were associated with increased graft loss (p<0.001). In the multivariate analysis, elderly donors were associated with increased risk of graft failure only when adjusted for recipient characteristics (HR 1.32, 95% CI 1.11-1.56) or center and regional factors (HR 1.23; 95% CI 1.04-1.46) individually; however, in the adjusted analysis including all these factors together, elderly donors did not carry increased risk of graft failure. Conclusions: Currently, the use of elderly liver allografts is limited to selected recipients (older age, less severe disease) by high volume centers in regions of high wait list mortality. Adjusted analysis of graft survival confi rms that the use of elderly donors in appropriately selected recipients and centers results in acceptable graft survival. Abstract# 623 Renal Dysfunction, MELD Scores, and Overall Survival of Patients With Liver (LT) Alone and Simultaneous Liver Kidney (SLK) Transplantation: A Fresh Examination of the UNOS Data. S. Habib, E. Meister, A. Rana, T. Boyer. Liver Institute, University of Arizona, Tucson, AZ. Introduction: Liver transplantation allocation is based on the policy; sickest fi rst. Especially with “share 35 allocation”, most patients will get transplanted at MELD 623 Renal Dysfunction, MELD Scores, and Overall Survival of Patients With Liver (LT) Alone and Simultaneous Liver Kidney (SLK) Transplantation: A Fresh Examination of the UNOS Data. S. Habib, E. Meister, A. Rana, T. Boyer. Liver Institute, University of Arizona, Tucson, AZ. Introduction: Liver transplantation allocation is based on the policy; sickest fi rst. Especially with “share 35 allocation”, most patients will get transplanted at MELD > 35 Concerns about the new allocation policy include: 1. There is an inverse relationship between pre transplant MELD score & post transplant survival. 2. A signifi cant number of patients with high MELD scores have renal dysf., need renal replacement, and may require combined SLK Tx, resulting in loss of good number of renal allografts.

Outcomes from Combining Kidney Paired Donation and Desensitization: An Approach to Kidney Transplantation for the Most Highly Sensitized Patients: 2474

1383 Incidence of Hypertension in Living Kidney Donors and Matched Controls. A. Massie, X. Luo, B. Boyarsky, N. James, D. Scharfstein, J. Alejo, D. Segev. Johns Hopkins, Baltimore, MD. Hypertension has been reported in living kidney donors, but is also common in the general population. Previous studies comparing hypertension in live donors to controls have suffered from inadequate controls and short followup time. We compared incidence of hypertension in living kidney donors, obtained from patient interviews and medical records, to healthy matched controls drawn from two community-based observational studies (ARIC and CARDIA studies). Controls with contraindications to live kidney donation at entry into study were excluded from analysis. We produced cumulative incidence curves adjusted by age to account for differential followup by age in the nondonor cohort, and analyzed hypertension incidence using Cox regression, adjusting for age, race, gender, and BMI. Age-adjusted cumulative incidence at 5, 10, and 15 years was 10.0%, 25.2%, and 42.1% in live donors, and 10.6%, 22.2%, and 35.0% in controls. There was no evidence of association between donor status and incident hypertension (aHR = 0.88 1.07 1.29, p=0.5). Age-adjusted cumulative incidence appeared to increase faster in donors than in controls beyond 8 years (Figure 1). Association between donor status and hypertension beyond 8 years was suggestive, but not statistically signifi cant (aHR = 0.96 1.53 2.42, p=0.07). Our retrospective cohort study found no evidence of association between donor status and hypertension in the fi rst eight years following donation. Incidence in donors may increase beyond 8 years after donation. New Onset Diabetes after Kidney Transplantation Tuesday, July 29, 2014 11:15 AM 12:45 PM Room 2018/2020 Abstract# 1391 Glycaemic Profi le Early After Kidney Transplantation: Highs, Lows and Diagnostic Dilemmas. P. Clayton,1,2 G. Lonergan,1 K. Wyburn,1,2 S. Chadban.1,2 1Transplantation, Statewide Renal Services, Sydney, NSW, Australia; 2Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Aims: The pathogenesis of hyperglycaemia after kidney transplantation differs from diabetes in the general population. Diagnostic and monitoring strategies extrapolated from general population studies may therefore not be appropriate. We aimed to characterise the glycaemic profi le early after transplantation and to assess the correlations between glycaemic profi le, oral glucose tolerance test (OGTT) and HbA1c. Methods: We recruited patients undergoing kidney transplantation at a single centre over 2011-13, and measured glucose with a continuous glucose monitor (CGM) that samples interstitial glucose every 5 minutes. CGM was performed during the fi rst 6 days post transplant and CGM, OGTT and HbA1c at months 3 and 6. OGTT was omitted for participants on treatment for diabetes. We defi ned hypoglycaemia as glucose<3.5mmol/L and hyperglycaemia as glucose≥11.1mmol/L. Results: Participants (n=28) were predominantly Caucasian (79%), male (64%), mean age 44±16.4, received a live (20, 71%) or deceased (8, 29%) donor kidney and received basiliximab, tacrolimus, mycophenolate and steroids. CGM recordings were available for 28 (100%) patients at transplant, 25 (89%) at month 3 and 21 (75%) at month 6. At transplant 8/28 had ≥1 hypoglycaemic episode and 25/28 had ≥1 hyperglycaemic episode. At month 3, 7/25 had ≥1 hypoglycaemic episode, none of whom were receiving hypoglycaemic therapy; and 14/25 had ≥1 hyperglycaemic episode, 3 of whom had a normal OGTT. At month 6, 4/21 had hypoglycaemia (3 not on hypoglycaemic therapy) & 5/21 had hyperglycaemia. OGTT results at month 3 correlated with nocturnal but not peak glucose. 1391 Glycaemic Profi le Early After Kidney Transplantation: Highs, Lows and Diagnostic Dilemmas. P. Clayton,1,2 G. Lonergan,1 K. Wyburn,1,2 S. Chadban.1,2 1Transplantation, Statewide Renal Services, Sydney, NSW, Australia; 2Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Aims: The pathogenesis of hyperglycaemia after kidney transplantation differs from diabetes in the general population. Diagnostic and monitoring strategies extrapolated from general population studies may therefore not be appropriate. We aimed to characterise the glycaemic profi le early after transplantation and to assess the correlations between glycaemic profi le, oral glucose tolerance test (OGTT) and HbA1c. Methods: We recruited patients undergoing kidney transplantation at a single centre over 2011-13, and measured glucose with a continuous glucose monitor (CGM) that samples interstitial glucose every 5 minutes. CGM was performed during the fi rst 6 days post transplant and CGM, OGTT and HbA1c at months 3 and 6. OGTT was omitted for participants on treatment for diabetes. We defi ned hypoglycaemia as glucose<3.5mmol/L and hyperglycaemia as glucose≥11.1mmol/L. Results: Participants (n=28) were predominantly Caucasian (79%), male (64%), mean age 44±16.4, received a live (20, 71%) or deceased (8, 29%) donor kidney and received basiliximab, tacrolimus, mycophenolate and steroids. CGM recordings were available for 28 (100%) patients at transplant, 25 (89%) at month 3 and 21 (75%) at month 6. At transplant 8/28 had ≥1 hypoglycaemic episode and 25/28 had ≥1 hyperglycaemic episode. At month 3, 7/25 had ≥1 hypoglycaemic episode, none of whom were receiving hypoglycaemic therapy; and 14/25 had ≥1 hyperglycaemic episode, 3 of whom had a normal OGTT. At month 6, 4/21 had hypoglycaemia (3 not on hypoglycaemic therapy) & 5/21 had hyperglycaemia. OGTT results at month 3 correlated with nocturnal but not peak glucose. HbA1c correlated poorly with CGM mean glucose at month 3 (P=0.5) and moderately at month 6 (P=0.06). Conclusions: Hypoglycaemic and hyperglycaemic excursions are very common early after kidney transplantation. A normal 3-month OGTT does not exclude hyperglycaemia. HbA1c should not be used to monitor glycaemic control in the fi rst 3 months post-transplant. Abstract# 1392 Vitamin D Defi ciency Is a New Independent Risk Factor of NODAT for Kidney Transplant Recipients. J. Dantal,1 A. Lefur,1 F. Gillaizeau,2 D. Masson,3 M. Giral,1 M. Fournier.2 1Nephrology, Clinical Immunologye and Transplantation, ITUN, Nantes, French Guiana; 2Statistical, SPHERE Laboratory EA-4275, Nantes, France; 3Biology, Nantes University Hospital, Nantes, France. New-onset diabetes after transplantation (NODAT) is frequently encountered after kidney transplant. The incidence of NODAT is infl uenced by both traditional risk factors for type 2 diabetes and transplant-specifi c risk factors. In addition, experimental studies have shown that vitamin D is important for glucose induced insulin secretion and improves insulin resistance. Epidemiological studies have largely documented that vitamin D defi ciency is associated with higher risk of type 2 diabetes in general population,. The aim of this monocentric and prospective study was to determine the infl uence of vitamin D status at time of the transplantation (Tx) on the development of NODAT and on patient and graft survivals. We have enrolled, adult recipients of a fi rst kidney Tx treated by CNI. We excluded patients with history of diabetes before Tx. Study population was divided among three groups according to vitamin D concentration at the time of transplantation (< 10 ng/mL, [10-30[ ng/mL or ≥ 30 ng/mL). 444 subjects were included from January 2000 to December 2011. Cumulative incidence of NODAT at one year post Tx was 13.4% [95%CI: 10.1%16.5%]. In multivariate analysis, we found that vitamin D defi ciency (ie <10 ng/ml) was associated with an increased risk of NODAT in the fi rst year post-Tx (HR versus ≥ 30 ng/mL = 2.62 [1.09-6.34], p=0.0320), whereas there was a trend for vitamin D insuffi ciency (ie [10-30[ ng/mL) although not statistically signifi cant (HR versus ≥ 30 ng/mL = 1.27 [0.58 – 2.76], p=0.5496). This association was independent from other well known risk factors of NODAT (HR in multivariate analysis [95%CI]): tacrolimus (4.59 [1.8-11.7]), age ≥ 55 years (2.40 [1.38-4.17]), BMI (for 1-unit increase: 1.76 [1.32-2.35]), and corticosteroids (2.36 [1.27-4.40]). There was no signifi cant association between Vitamin D status at Tx and patient and graft survival. Vitamin D status did not infl uence patient death and graft failure at one and fi ve years after Tx. Vitamin D defi ciency is a new risk factor of NODAT in the fi rst year following kidney Tx. We currently analyse the importance of Vitamin D levels as a new additional variable for predictive score of NODAT. Finally, Vitamin D substitution is an easy and non expensive therapy that seems able to preserve β-cell function in kidney transplant recipients. 1392 Vitamin D Defi ciency Is a New Independent Risk Factor of NODAT for Kidney Transplant Recipients. J. Dantal,1 A. Lefur,1 F. Gillaizeau,2 D. Masson,3 M. Giral,1 M. Fournier.2 1Nephrology, Clinical Immunologye and Transplantation, ITUN, Nantes, French Guiana; 2Statistical, SPHERE Laboratory EA-4275, Nantes, France; 3Biology, Nantes University Hospital, Nantes, France. New-onset diabetes after transplantation (NODAT) is frequently encountered after kidney transplant. The incidence of NODAT is infl uenced by both traditional risk factors for type 2 diabetes and transplant-specifi c risk factors. In addition, experimental studies have shown that vitamin D is important for glucose induced insulin secretion and improves insulin resistance. Epidemiological studies have largely documented that vitamin D defi ciency is associated with higher risk of type 2 diabetes in general population,. The aim of this monocentric and prospective study was to determine the infl uence of vitamin D status at time of the transplantation (Tx) on the development of NODAT and on patient and graft survivals. We have enrolled, adult recipients of a fi rst kidney Tx treated by CNI. We excluded patients with history of diabetes before Tx

OUTCOMES OF PATIENTS DESENSITIZED FOR A POSITIVE CROSSMATCH COMPARED TO PATIENTS WHO ARE NOT OFFERED THIS OPTION: 2849

Sharif A.1, Lonze B.2, Hillier J.2, Zachary A.3, Leffell M.3, Alachkar N.4, Kraus E.4, Dagher N.2, Desai N.2, Segev D.2, Montgomery R.2 1Queen Elizabeth Hospital Birmingham, Renal Institute of Birmingham, Birmingham, United Kingdom, 2Johns Hopkins Medical Institutions, Department of Transplant Surgery, Baltimore, United States, 3Johns Hopkins Medical Institutions, Department of Immunogenetics, Baltimore, United States, 4Johns Hopkins Medical Institutions, Department of Transplant Nephrology, Baltimore, United States

Paired kidney donation and optimizing the use of live donor organs

B.E. Lonze1, D.L. Segev2, N.N. Dagher1, C.E. Simpkins1, J.E. Locke1, L.M. Kucirka1, A.L. Singer1, A.A. Zachary3, R.A. Montgomery4 1Surgery, Johns Hopkins, Baltimore/MD/UNITED STATES OF AMERICA, 2, Johns Hopkins University School of Medicine, Baltimore/ UNITED STATES OF AMERICA, 3Medicine, Johns Hopkins University, Baltimore/UNITED STATES OF AMERICA, 4Surgery, Johns Hopkins University, Baltimore/UNITED STATES OF AMERICA